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Lifestyle-modification programmes

Lifestyle-modification programmes in Arab states criticised

The meta-analysis confirmed that the lifestyle-modification programmes delivered were no more effective than other treatments

Most studies showed no significant reduction in body weight, and the meta-analysis confirmed that these lifestyle-modification programs were no more effective than as-usual treatments, according to a group of Lebanese investigators from the Department of Nutrition and Dietetics of Beirut Arab University (BAU) situated in Beirut, and their colleagues from the Department of Eating and Weight Disorders from Villa Garda Hospital.

Obesity is a growing health problem worldwide, and is associated with serious medical comorbidities and an increased risk of mortality. This scenario is present also in Arabic-speaking countries, where around 6-8% of the total population of the world lives. Recent epidemiological studies have reported that a significant proportion of their citizens, especially females, are heavily affected by or obesity or are overweight, foremost in Kuwait, Egypt, UAE, Bahrain, Jordan and Saudi Arabia.

The Lebanese investigators conducted a systematic review, with the aim to assess the effectiveness of the available lifestyle-modification programs for weight management delivered in Arabic-speaking countries. Six studies, conducted in four Arab countries, namely Kuwait, Saudi Arabia, United Arab Emirates and Bahrain, met the inclusion criteria. Their paper, ‘Long-term Lifestyle-modification Programs for Overweight and Obesity Management in the Arab States: Systematic Review and Meta-analysis’, was published in Current Diabetes Reviews.

They identified six studies conducted in four Arab countries, comprising a total of 444 adolescent and adult participants of both genders with overweight and obesity, met the inclusion criteria and were reviewed. Most studies that assessed weight loss at si-month follow-up showed no significant reduction in body weight.

The meta-analysis confirmed that the lifestyle-modification programmes delivered were no more effective than other treatments. Only one article reported significant weight-loss maintenance after 12 months of follow-up. However, this was a prospective non-controlled study in which the weight loss maintained (=4%) did not conform to the standard for clinical significance (>10%).

"On a global scale, lifestyle-modification programmes based on behavioural or cognitive behavioural treatment combined with specific recommendations on diet and exercise are considered the cornerstones of weight management, as they have been shown to determine improvements in weight-related medical comorbidities and quality of life, and are therefore recommended as first choice treatments by international guidelines,” said principle investigator, Dr Marwan El Ghoch, from Villa Garda Hospital, and visiting professor in Beirut Arab University.

However, he underlines that some major factors may be implicated in discrepancies between international findings (US and Europe) and those derived from the Arabic-speaking countries in regard.

"First, based on our results, we noticed substantial methodological weaknesses in the transcultural adaptation and development of behavioural treatments, e.g. lifestyle-modification programmes not taking into account linguistic and socioeconomic context of diverse groups. Indeed, it is uncertain whether the evidence-based treatments developed within a particular context are applicable to different populations with different language, culture and values. It is also important to note that none of the studies included in our systematic review relied on direct supervision by clinical experts in lifestyle modification either before or during program implementation. Last but not least, there are traditional restrictions to lifestyle choices in Arab countries, in particular there are certain social and cultural obstacles to females developing healthier lifestyles (i.e. dietary issues and limited access to sporting/exercise activities)".

The study concluded that lifestyle-modification programmes for weight management delivered in Arabic-speaking countries seem lacking in effectiveness due to methodological weaknesses in program adaptation, a lack of expert clinical supervision before and during implementation, and the presence of barriers to lifestyle modification, especially for women. Future studies should bear these features in mind.

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